To assess the effect of pre-hospital antibiotic treatment given by general practitioners to patients with meningococcal disease.
A 16-year population-based historical follow-up study based on referral letters and hospital records in the County of North Jutland, Denmark.
320 patients with meningococcal disease, of whom 302 were examined by a general practitioner before admission to hospital.
44 patients (14.6%) were given antibiotic treatment by the referring general practitioner.
Nine of these (20.5%) died, compared with 16 (6.2%) patients who did not receive pre-hospital antibiotic treatment.
The presence of skin bleeding, petechiae, and impaired consciousness were strongly associated with case fatality.
Even after adjustment for these variables the odds ratio (OR) for death in patients treated with antibiotics was high (OR=3.2 ; 95% Cl, 0.9-10.6).
In the 15 patients with skin bleeding (ecchymoses, suggillations) the case fatality rate was 100% in patients treated with antibiotics, and 50% in patients who did not receive antibiotics before hospitalization.
If skin bleeding was replaced in the models by the presence of disseminated intravascular coagulation on admission, the OR for death in patients with pre-hospital antibiotic treatment was 35.9 (95% Cl, 2.9-441.8) in the presence of disseminated intravascular coagulation and 1.9 (95% CI, 0.2-19.5) in its absence. (...)
Mots-clés Pascal : Méningococcie, Bactériose, Infection, Antibiotique, Période préhospitalière, Epidémiologie, Chimiothérapie, Traitement, Efficacité traitement, Homme, Danemark, Europe, Antibactérien, Antiinfectieux
Mots-clés Pascal anglais : Meningococcal disease, Bacteriosis, Infection, Antibiotic, Prehospital period, Epidemiology, Chemotherapy, Treatment, Treatment efficiency, Human, Denmark, Europe, Antibacterial agent, Antiinfectious
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0453188
Code Inist : 002B05B02I. Création : 25/01/1999.